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Background Service user participation contributes to the improvement of health care services for the betterment of conditions experienced by patients. However, there is a lack of knowledge about how adolescents and young adults (AYAs) experience involvement processes in practice and what it would take to achieve a high degree of involvement according to AYAs. Objectives To explore (1) how AYAs with cancer experienced involvement processes during participation in three different service user involvement initiatives (development of an ap